Do vitamins and supplements really promote wellness?

How many vitamin bottles adorn your counter? Many Americans have quite a collection. Almost 80 percent of Americans report consuming daily supplements. The vitamin and supplement 50 billion industry spends 900 million on advertising. The barriers to entry into this lucrative business are low: the makers and marketers never had to prove efficacy, do not need FDA approval, and carefully crafted health and vigor declarations – that fall just a tad short from health claims – are exaggerated if not outright misleading, yet are legal. The vitamin and supplement industry receives very little oversight.

People are naturally concerned about filling nutritional gaps in their diet. People would also like to optimize their health and fitness. The vitamin and supplement marketing messages fall on receptive ears because who could say no to effortless prevention, enhancement, beauty and stamina. 

Vitamins and supplement additives are clearly useful for correcting vitamin and mineral deficiencies. Vegan diets, for instance, don’t contain enough if any B12 and need supplementation with this vitamin. Folic acid and iron supplementation is recommended during pregnancy – folic acid supplementation is proven to reduce the incidence of neural tube defects, and folic acid is advised for anyone pregnant or planning a pregnancy.

What about the rest of us?

Updated recommendations published by the US Preventive Services Task Force, an independent volunteer group of national experts in prevention and evidence-based medicine, sorted through the vitamin and supplement scientific data. The recommendations follow a systematic review of 84 studies, among them an additional 52 new studies since the previous review.

For healthy adults who are not pregnant, and not diagnosed with a deficiency, the US Preventive Services Task Force states that “current evidence is insufficient to assess the balance of benefits and harms of the use of multivitamin supplements, single supplements, or most paired supplements for the prevention of cardiovascular disease or cancer.”

The task force specifically recommends avoiding beta carotene (possible increased risk of heart disease and lung cancer) and vitamin E supplements. 

As to multivitamins: there’s “insufficient” evidence, the task force concludes.

The appeal of the pill

In a new editorial in JAMA scientists from Northwestern University support the new recommendations.

The authors start with the well supported fact that “eating fruits and vegetables is associated with decreased cardiovascular disease and cancer risk.” It’s reasonable to assume that if key components of the fruits and vegetables can be extracted and compacted into a pill these pills would do the same, at lesser effort and expense.

Alas, fruits and vegetables can’t be mimicked by a pill, as plants contain a myriad of compounds: besides the known vitamins and minerals, also fiber, phytochemicals, and many more micronutrients, working in concert. We (that includes the microbes living within us) have co-evolved with plants and are adapted to metabolize these foods. 

What’s the harm?

If it won’t help, it can’t hurt, is what many say as they pop in a bunch of vitamins.

The task force begs to differ.

As mentioned above, there was increased risk of lung cancer among smokers who took beta carotene supplements. Taking vitamin A may reduce bone density. Vitamin D supplementation can cause high blood levels of calcium and kidney stones. 

Beyond that, supplements are a waste of money and  – even worse – squandered attention, states the Northwestern physicians editorial, led by Jeffrey Linder, MD. “Rather than focusing money, time, and attention on supplements, it would be better to emphasize lower-risk, higher-benefit activities. Individual, public health, public policy, and civic efforts should focus on supporting people in regular preventive care, following a healthful diet, getting exercise, maintaining a healthy weight, and avoiding smoking.”

Real food is the best source of nutrients, and plant foods are more than the sum of their known nutrients. Decades of controlled studies of vitamin and mineral supplementation have been largely disappointing.

Although eating well and exercising isn’t always easy, the multivitamin and supplement “insurance policy” may be standing in your way to committing to improving your diet.

Dr. Ayala